Offer discussion

[ranboot]

Hello Everyone, Hem/Onc fellow here graduating next year. Currently in the process of interviewing
and would like to know what would be a fair offer for J1 waiver position. I have got an initial offer (hospital based employer in lower mid-west) of 440k as a 2 year-guaranteed salary, with option to switch to rvu based model after first year with 3 tiers: tier 1 at 0-4698 at 89.73$ per wRVU, tier 2 at 4699 - 6179 at $92.51$, and tier 3 with 6180+ at 95.37$. It is an HPSA site so there will be geographic conversion factor for rvu. This will be a 3-year j1 waiver contract. Other noteworthy benefits that come with it are 5% 401k employer contribution, 25k sign-on bonus, 10k relocation, 1k residency stipend, 5k CME.
- They told me that they are open to negotiation. so I would like to know what are the things that I should be negotiating. I believe sign-on, relocation, CME they might be willing to negotiate but not sure about the rvu ranges and $/rvu.
- Not sure if I can ask for fixed $/rvu (heard 100$ per rvu fixed is fair) , instead of a tier system
- Can someone also share data from MGMA, Sullivan Cotter, etc. on patient numbers, rvus, compensation at various percentiles in midwest.
- What would be a comfortable and at a stretch rvu target and patient numbers for someone fresh out of fellowship.
- Anything that should go on contract to minimise any exploitation being on J1 contract.
- How to decide if the $/rvu rates for the tiers are fair esp. when as oncologists hospitals make profits from chemo and other upward services

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[gutonc]

Hello Everyone, Hem/Onc fellow here graduating next year. Currently in the process of interviewing
and would like to know what would be a fair offer for J1 waiver position. I have got an initial offer (hospital based employer in lower mid-west) of 440k as a 2 year-guaranteed salary, with option to switch to rvu based model after first year with 3 tiers: tier 1 at 0-4698 at 89.73$ per wRVU, tier 2 at 4699 - 6179 at $92.51$, and tier 3 with 6180+ at 95.37$. It is an HPSA site so there will be geographic conversion factor for rvu. This will be a 3-year j1 waiver contract. Other noteworthy benefits that come with it are 5% 401k employer contribution, 25k sign-on bonus, 10k relocation, 1k residency stipend, 5k CME.
- They told me that they are open to negotiation. so I would like to know what are the things that I should be negotiating. I believe sign-on, relocation, CME they might be willing to negotiate but not sure about the rvu ranges and $/rvu.
- Not sure if I can ask for fixed $/rvu (heard 100$ per rvu fixed is fair) , instead of a tier system
- Can someone also share data from MGMA, Sullivan Cotter, etc. on patient numbers, rvus, compensation at various percentiles in midwest.
- What would be a comfortable and at a stretch rvu target and patient numbers for someone fresh out of fellowship.
- Anything that should go on contract to minimise any exploitation being on J1 contract.
- How to decide if the $/rvu rates for the tiers are fair esp. when as oncologists hospitals make profits from chemo and other upward services

I can answer a few of those questions.

Those tiers appear to correspond roughly to 25th/50th/75th %iles of MGMA (or maybe AAMG or other survey). I don't know the midwest data, but that's pretty close to the Western region data. The $/wRVU is also "in-range". Base seems reasonable as well. Remember that all that sweet chemo cash is used not just to pay you, but also all the other people it takes to run an oncology clinic. Chemo RNs and pharmacists ain't cheap.

No harm in trying to negotiate as you described above. I think flattening the $/wRVU and putting it in the $90-95 category is a good idea. I am familiar the comp plans of 3 community based oncology groups in my area, none of which are true PP, and that's what they all pay. Not saying you can't ask for $100, but you're more likely to be successful a hair lower than that. Same with trying to bump the sign/relocation bonuses and CME allowance. I'd also check into PTO and CME time.

As for productivity, that is variable and kind of up to you and the practice. I have hired 6 physicians in the last 3 years for my group, half of them straight out of fellowship. All but 2 of them are >25th %ile productive and one is >50th %ile. So it's definitely do-able, especially if you have the clinic support you need.

 

[ranboot]

I can answer a few of those questions.

Those tiers appear to correspond roughly to 25th/50th/75th %iles of MGMA (or maybe AAMG or other survey). I don't know the midwest data, but that's pretty close to the Western region data. The $/wRVU is also "in-range". Base seems reasonable as well. Remember that all that sweet chemo cash is used not just to pay you, but also all the other people it takes to run an oncology clinic. Chemo RNs and pharmacists ain't cheap.

No harm in trying to negotiate as you described above. I think flattening the $/wRVU and putting it in the $90-95 category is a good idea. I am familiar the comp plans of 3 community based oncology groups in my area, none of which are true PP, and that's what they all pay. Not saying you can't ask for $100, but you're more likely to be successful a hair lower than that. Same with trying to bump the sign/relocation bonuses and CME allowance. I'd also check into PTO and CME time.

As for productivity, that is variable and kind of up to you and the practice. I have hired 6 physicians in the last 3 years for my group, half of them straight out of fellowship. All but 2 of them are >25th %ile productive and one is >50th %ile. So it's definitely do-able, especially if you have the clinic support you need.

Thank you!!
I guess it would be good to have mix of both guaranteed salary and production bonus at the beginning rather than just a guaranteed base. In a guaranteed salary with no production bonus, not sure if they can line up patients for me. Do you mind sharing MGMA numbers of patients, rvus, compensation for midwest region for different percentiles. Flattening rvu would mean say for $95/rvu, if I am getting a base of 440k, then my production bonus should start from the threshold of 440k/95 rvus at 95$/rvu.

 

[gutonc]

Thank you!!
I guess it would be good to have mix of both guaranteed salary and production bonus at the beginning rather than just a guaranteed base. In a guaranteed salary with no production bonus, not sure if they can line up patients for me.

That's kind of the point of a guaranteed base for a new physician. You are unlikely to be able to start at 25th %ile productivity straight out of fellowship, or at least be able to do it well.

Do you mind sharing MGMA numbers of patients, rvus, compensation for midwest region for different percentiles.

I don't have that data. As mentioned, the RVU numbers you quoted above for those tiers are pretty close to 25/50/75. In order to figure out how to get those #s based on patient volume, you can just use the wRVU #s from CMS. Roughly speaking, to get to 25th %ile, you will need to see ~60pts/wk with ~15% of them new patients.

Flattening rvu would mean say for $95/rvu, if I am getting a base of 440k, then my production bonus should start from the threshold of 440k/95 rvus at 95$/rvu.

That means that you would say "If I make my guarantee based on wRVUs, I'll get paid $95 (or whatever) /wRVU.